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Effects of a postoperative resistive exercise program on the knee extension and flexion torque in children with
Dimitrios Patikas1, Sebastian I Wolf, Petra Armbrust
1Department of Orthopaedic Surgery, University of Heidelberg, Germany. Dimitrios.Patikas@ok.uni-hd.de
Insights
Resistive exercise did not improve knee strength or function in children with cerebral palsy after orthopedic surgery compared to conventional physiotherapy alone. Long-term, home-based programs showed no additional benefits for rehabilitation outcomes.
Area of Science:
- Orthopedics
- Rehabilitation Medicine
- Pediatric Physical Therapy
Background:
- Multilevel orthopedic surgery is common for children with spastic diplegic cerebral palsy (CP).
- Rehabilitation aims to restore motor function and strength, particularly around the knee joint.
- The efficacy of supplementary resistive exercise programs requires investigation.
Purpose of the Study:
- To evaluate the impact of a home-based resistive exercise program on knee extension and flexion torque production in children with CP post-surgery.
- To compare outcomes between children receiving conventional physiotherapy plus resistive exercise and those receiving conventional physiotherapy alone.
Main Methods:
- A randomized clinical trial involving 39 children with spastic diplegic CP (ages 6-16).
- Participants were allocated to an exercise group (n=19) or a control group (n=20).
- The exercise group underwent a 9-month home-based resistive program starting 3 months post-surgery, alongside conventional physiotherapy.
Main Results:
- Knee extension and flexion torque decreased at 6 months post-surgery but returned to preoperative levels by 1 year in both groups.
- No significant differences in strength recovery or Gross Motor Functional Measurement (GMFM) were observed between the exercise and control groups.
- The Modified Ashworth Scale also showed no group-dependent changes.
Conclusions:
- A 9-month home-based resistive exercise program, initiated 3 months post-surgery, did not provide additional benefits over conventional physiotherapy for strength and GMFM in children with CP.
- Conventional physiotherapy alone appears sufficient for achieving strength and functional recovery in this population.
- Future research could explore earlier or different types of exercise interventions.
Objective:
To investigate the effects of resistive exercise on the knee extension and flexion torque production during the rehabilitation period after multilevel orthopedic surgery.
Design:
Randomized clinical trial.
Setting:
Hospital rehabilitation department.
Participants:
Thirty-nine children with spastic diplegic cerebral palsy (CP) (age range, 6-16 y), randomly allocated to an exercise group (n=19) and a control group (n=20). All received conventional physiotherapy (PT), and the exercise group also followed a resistive exercise program.
Intervention:
A 9-month standardized home-based resistive exercise program, which started about 3 months after the surgery.
Main Outcome Measures:
The Gross Motor Functional Measurement (GMFM) assessed before (E(0)) and 1 year (E(1)) after the surgery. The Modified Ashworth Scale and the isometric and isokinetic torque of the knee extensors and flexors were evaluated at E(0), E(1), and 6 months after the surgery.
Results:
The knee extension and flexion moments had decreased 6 months after the surgery and recovered to the preoperative level 1 year after surgery. These changes were not group dependent.
Conclusions:
Additional long-term, home-based, low-cost resistive exercise that starts soon after the operation of patients with CP was not more beneficial than conventional PT only, in terms of strength and GMFM.
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